Learning from and about cancer (chronic lymphocytic leukemia or CLL) by Dr. Brian Koffman

What started as a personal journey of a doctor turned patient morphed into a way to share what’s universal in dealing with cancer, in my case a nasty leukemia (CLL), a failed transplant and a successful clinical trial. The telling of my journey has become a journey to teach about CLL, related blood issues and all cancers. Please visit our new website http://cllsociety.org for the latest news and information. Smart patients get smart care™. If you want to reach me, email bkoffmanMD@gmail.com

Saturday, October 31, 2009

The news from the LRF Conference and the consultations with my NY doctors

What’s new you ask?

The conference and the meeting with my NY doctors helped clarify my future, even if there was the usual extreme divergence of opinion. Sometimes I think that my survival depends on finding ways to mine the wisdoms of all the different CLL gurus who are often separated by huge chasms in how they approach this illness, a disease so multifaceted that it makes the Hope Diamond look like a glass trinket.

Here is one of the many overly simplistic ways to dice the tomato.

It is fair to say there are two general schools of thought in the CLL community. The futurists and the pragmatists.

The first group’s mantra is that we need to be gentle, we need to avoid risk and toxicity so we can fight again, which we surely need to do.

In the meantime, new wonder drugs are in the pipeline, many of which. like a well scrubbed debutant, had their public coming out at the LRF conference.

They include exciting targeted small molecules that with tight focus interfere with the B cell clone ability to communicate with its neighbors that nourish and protect it from attack and encourage its growth.

New molecules that interfere with its ability to proliferate or with its annoying inability to to die when it gets the signal it is time to self destruct.

New monoclonal that attack more and more specific CLL targets, refusing to say hello and goodbye to even other B cells.

New drugs, often sons and daughters of older ones that modify the immune system in ways not well understood, but that seem to shrink the tumor burden by bringing the cancer to the attention of the authorities.

New gene therapies and vaccines that are finding ways to rekindle the immune systems and getting it to recognize the danger afoot or to resensitize the cancer cells to old killers.

New combinations are being worked out that are smarter with fewer side effects and bigger kill rates.

Watch for more on Cal 101, SYK inhibitors, IMIDs, mTors and others here and at all your favorite CLL haunts.

To these CLL warrior doctors, many of whom split their time between the clinic and the research lab, a stem cell transplant is a blunt weapon, full of certain risk and collateral damage. A must to avoid in all but the most desperate cases. An end game maneuver. If we are smart upfront, we can play this out a long long way. The trick is to avoid drug toxicity and still keep the disease from escaping control.

Don’t let the disease or its treatment kill you with a single fatal blow or a thousand tiny lashes.

Go gently forward. Look at the evidence in the trials and the underlying science. Prod around and don’t always accept the conventional wisdom, but don’t ignore the evidence. Every case is unique.

The brilliant Dr. Furman is of this ilk. He questions everything. He scans the data and needs to be convinced. He is not certain that I even have ITP. Conflicting evidence. He wants to me to hold the IVIG and see what happens. If my platelets fall without the gamma globulin coating to protect them, he recommends Rituxan, but maybe steroids or even a trial of a SYK inhibitor. Works for both CLL and ITP. He is worried about a second transplant and prefers the exciting and cleaner promise of CAL 101 or a revlimid trial. He thinks good old fashion FCR would be a great choice for me with my 11q del. He is not worried about my ITP with the FCR.

The wise and experienced Dr. Rai is more a pragmatist (not that Dr. Furman isn’t practical or Rai isn’t a world class researcher). Last time I saw him he said: DON’T DO ANYTHING STUPID. This time he refused to predict the future. He said every CLL doctor would give you a different opinion. Ain’t that the truth. He said no need to change a winning course. This is definitely ITP because the IVIG is helping. No testing needed. Don’t chase the possible accessory spleens seen on my last CT scans. He says it could be helpful very long term and there are many options if the IVIG stops working. He said I will DEFINITELY need a second transplant. That was as clear as the crystal from which the Queen sips her champagne. He told me that he has had patients that have done very well with a second transplant. He leaves the timing and the path to that to my transplant doctor. That is not his area of expertise, but my tumor load is low now, so there is no urgency. He is strongly against FCR when the time comes to treat the CLL in anticipation of the transplant. He acknowledges that others feel it is safe, but his assessment is that the evidence is weak.

I like most of what Rai has to say. Rai is dealing with what is on the ground now, not what is on the come. The future always looks rosy to the researcher.

I think I will see how long I can ride out the IVIG. Maybe I can stretch the time between treatments to 3 weeks checking Dr. Furman's hypothesis that it may not be ITP by monitoring if my counts falls off a cliff in that extra week without my protein sheath on my platelets.

If it stops working all together, I would like to jump to either HDMP+R for both the CLL and the ITP, then transplant. Or maybe just R to get the ITP whipped into shape, followed by FCR with transplant redux on its heels.

Halloween Hockey Dad

Thursday, October 29, 2009

Money well spent

This is what we need to do to find a cure. Thanks to all who helped by volunteering for a study or writing a check. We have more to do.

FOR IMMEDIATE RELEASE

Marion F. Swan

(212) 349-6435 / (347) 920-6680

mswan@lymphoma.org

Lymphoma Research Foundation Announces Recipients of CLL/SLL Research Initiative Grants

Second Round of Grants Brings Overall Total to $2,375,000

New York, NY … The Lymphoma Research Foundation (LRF) is pleased to announce that David Frank, MD, PhD of the Dana-Farber Cancer Institute and Thomas Kipps, MD, PhD, Moores Cancer Center, University of California, San Diego are the recipients of the second round of funding under the Foundation’s Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL) Research Initiative.

Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) are the same disease with slightly different manifestations. Where the cancerous cells gather determines whether it is called CLL or SLL. When the cancer cells are primarily found in the lymph nodes, lima bean shaped structures of the lymphatic system, an essential part of the body’s immune system, it is called SLL. When most of the cancer cells are in the bloodstream and the bone marrow, it is called CLL.

John Balan, founder of the CLL Information Group with membership of approximately 1000 patients and caregivers, expressed the group’s delight with these two awards. “We have a great deal of respect for the work that Drs. Kipps and Frank have been doing with CLL. These two awards will only augment what they have already done and add to the arsenal of treatments available to patients.”

The purpose of Dr. Frank’s, A Clinical Trial of STAT3 Inhibition in Patients with CLL, will be to evaluate the benefits of targeted therapy for CLL/SLL patients. Through prior research, Dr. Frank and his team found that CLL/SLL cells are characterized by an abnormality in a protein called STAT3, which regulates genes controlling the abnormal proliferation of lymphocytes in patients with this disease. They further identified a drug that inhibits STAT3, and, with the two-year $300,000 grant from LRF, Dr. Frank will carry out a clinical trial to test its safety and effectiveness in CLL/SLL patients. This is Dr. Frank’s second LRF grant supporting his efforts to discover more effective CLL/SLL therapeutics.

Dr. Kipps’ “Gene-Chemoimmunotherapy for Intractable Chronic Lymphocytic Leukemia” will focus on developing a treatment option for CLL/SLL patients with refractory disease who have limited treatment options. Dr. Kipps and his team have found that gene-immune therapy can render drug-resistant cells sensitive to chemotherapy. With this two-year $200,000 grant, Dr. Kipps will examine the mechanism(s) of drug-resistant disease and will pursue a clinical trial examining the use of gene-immune therapy to improve the capacity of patients with CLL/SLL refractory disease to respond to chemotherapy. Dr. Kipps is a member of the Foundation’s Scientific Advisory Board.

About the Lymphoma Research Foundation

The Lymphoma Research Foundation (LRF) is the nation's largest voluntary health organization devoted exclusively to funding lymphoma research and providing patients and healthcare professionals with critical information on the disease. LRF's mission is to eradicate lymphoma and serve those touched by this disease.

As of June 30, 2008, LRF has funded over $37 million in lymphoma-specific research. LRF also provides a comprehensive series of programs and services for patients, survivors and loved ones affected by lymphoma, including our toll-free Lymphoma Helpline and Clinical Trials Information Service, in-person patient education programs, webcasts/teleconferences and support services. Follow us on twitter or become a fan on facebook.

Monday, October 26, 2009

The LRF Conference

Before I go into the details of what is new and important in CLL research, let me just remind you that we have today in the way of therapies, to be honest, is not all that great.

Most of us with CLL will die from CLL or its complications or the complications of its treatment. Unless the disease is truly indolent, or we are pretty old at time of diagnosis.

CLL is not a "chronic" disease because the treatments that allow us to live with it are so darn toxic, you can't keep them up for very long, and can maybe only repeat them once each if you are very lucky and very responsive. The only cure on the table today is a transplant with a 20% or more chance of killing you, a high risk of trading one incurable ailment (GVHD) for another and a 100% chance of robbing a year or more of your life as you recover, much of it feeling pretty punk.

Not that I am not grateful that we have these options. It is a much richer palette than 10 years ago,

But we need better. We need more research, We need more focused immunotherapy. more small targeted molecules, less toxic immunomodulators, new transplant protocols, and new paths to a cure that are still in the test tube.

Please support LRF and CIG (see link on my sidebar). The answer is in research. Please consider advocacy. CLL is the poor sister to the big cancer in the research budget. LRF can give you the tools to fight, not just for the cure, but let's be honest, first for the money for a cure.

Saturday, October 24, 2009

Live from New York

In the rain in NYC, at the Lymphoma Research Foundation Conference in Brooklyn, walking the Promenade looking across the river at the movie view lights of Manhattan, and reflecting on what I had garnered from the meeting so far.

But tonight truly belonged to PURE FOOD and WINE - probably the best raw restaurant in the world. A great time with my daughter, Tim and my wife.

Good news

Monday, October 19, 2009

Diet and Supplements

So I guess my raw diet isn't going to cure me, despite Dr. Gabriel Cousens admonishments about the evil of all things cooked and sweet.

Nevertheless, it is a healthy way to eat, and eating right can change you from the guts on out.

My plan is just to be a little less precious about my diet- a little more full of self forgiveness if I eat the occasional organic apple, or even take a bite of vegan triple chocolate cake.

No flesh food though. That is where I draw the line. If I could say no to smoked salmon in Vancouver, I think it would take some mighty impressive savory snack to push me to eat meat again.

Cheese is a whole other issue. But that is on hold for now too. All dairy is literally off the table.

It is just going to be a kinder gentler broader and sweeter diet. Still mostly raw.

Not changing much else.

Still on the Budwig diet- cheap and easy and safe- Flaxseed oil and essential fatty acids. I believe it has helped some cancer patients and it has no down side.

Still taking Zeolyte in powder form though I am underwhelmed by its detoxifying magic. The powder is much much cheaper than the liquid and makes more sense to me, but I suspect its main advantage is that I am just wasting less money than those who take Natural Cellular Defense.

Still drinking a pot load of green tea, but I am having my doubts there too with my low platelets. Spoke to Dr. Neil Kay of the Mayo Clinic ECGC study. He didn't think it was a factor, but some other CLLers have seen their platelet counts climb when they stopped the tea or the supplement.

Added a touch (2 mg) of copper) to balance out the zinc tablets which I now am biting in half to reduce my intake to 25 mg a day. That's what Dr. Andy Weil recommends, and he knows his vitamins and minerals. Trying to keep my immune system happy and well nourished.

Increased my Vit. D3 to a whopping 10,000 units a day to try to get my blood test into the high echelons of normal. Don't try this at home. Levels must be monitored. Blood must be tapped. (Sounds like the patriot act.) There is good evidence of the protective effects on the sunshine vitamin, but way less about it as a cure for anything other than rickets. I am hoping I am not starting too late on this one to get some benefits.

Also take magnesium because I am on a diuretic for my blood pressure, and Culturelle, a probiotic, just because.

And like all good vegans, I need some B12 supplementation (sublingual in my case). No B12 in the veggies grown in our depleted soils, even the organic ones.

A new friend is exploring LDN or low dose naltrexone to treat her mother's CLL. Looks non-toxic and no multi-level-marketing craziness. Kinda makes sense in stimulating immunity and might help in early disease. The literature is pretty thin, but it is interesting. I am thinking about it.

Still meditating. Still working out. Still being positive in thought and action.

Still welcoming all prayers. (please read my prior post) Still asking for forgiveness. Still trying to forgive myself.

My real hope lies in a redo transplant and not much else. This time for keeps.

Sunday, October 18, 2009

OMG -A Plea

I'm no poet. I don't say that out of false humility, but because I am blessed to know a few poets, and I know how long and hard they work to whittle their craft. I carve my words with a chain-saw.

Worse than that, I don't believe (well 80% of me doesn't believe) in a personal G-d that intervenes in the affairs of men. A G-d that answers our prayers. Seems too capricious, too wanton, too damn unfair. My theology is more random. More Tom Robbins, than Moses Maimonides.

But I couldn't sleep last night, and it was not a sore toe robbing me of sweet nature's balm.

It was the drive to push out these words, personally and publicly. Make the commitment. Be clear on my intentions. Maybe it was hearing the Sabbath Prayer from Fiddler at services on Friday night - I was always a sucker for sentimentality.

Maybe Kubler-Ross would say I was in the bargaining stage of grief, and she wouldn't be wrong.

But it is more than that. It is a sense that I should look everywhere for the answers, line up all the energies to move forward. Push in all directions. Maybe it's my 20% that does believe - the 80-20 principle doing its magic.

I will keep going.

OMG- A Plea

The road to sleep was blocked last night by a hard glimpse of what you said:

You said you love to give, and ask only that I give it all back.

I’m in. Are you?

You said you’d be loud and heard over the clutter if I loved you, but your silence is keeping me up at nights.

Maybe your screams will lull me back to sleep.

You didn’t break me. That took different work than you do. But you can cure me with your shock or tender therapy. I’m game for either.

I know that I am asking you to break the rules. No one will know. They never do.

And besides, you’ve done it before.

Remember the Sea of Reeds?

I’m no Moses, but I am asking to be healed- for your sake, for your name’s sake, for my family and friends and the others’ sake. For my sake

Saturday, October 17, 2009

Getting better all the time

My toe is 95% better with one anti-inflammatory tablet (Celebrex), some carefully placed protective padding, and a day spent sitting around with my feet up, catching up on critical paperwork that was way overdue.

So it was good that it was sore. Kept me grounded or should I say seated. At the end of the day, I feel much more in control of my upcoming projects due to my forced convalescence.

Now it looks like gout and infection are off my differential diagnosis list. Rest and one pill would not have made much of an impression on those suspects. Like trying to stop the Taliban with a polite memo.

A stress fracture is still a remote possibility. I will need to do some walking and see how it reacts, but I want to let it calm down for another 24 hours and I don't anticipate the flare-up that would demand further work-up. Right now I am enjoying the lack of swelling and pain.

Now If only Dr Scholl's made a protective pad to save my platelets, and Pfizer made a single pill to rid my body of a vulgar B lymphocyte clone.

Friday, October 16, 2009

Playing Footsies

My left foot suddenly hurts, and is swollen and very tender at the base of the first toe.

I share this with you, not to get your sympathy, though it does remind me how a neglected backwoods of the body can reek havoc on that self proclaimed higher organ that defines us as human, the one that is all grey and fissured.

I tell you of my woeful toe-full because it illustrates the workings of this doctor turned patient but still a doctor's worrying organ.

I am immediately considering infection complicated by my wimpy immunity or gout due to my increased cell turnover with my ITP, or an occult stress fracture, secondary to transplant induced and yet undiagnosed osteoporosis. I see blood work and aspirations, x-rays, bone scans, DEXA tests, MRIs. I see meds and casts and crutches. I see trips cancelled, incisions made, and big operations considered and rejected because of low platelets. I see heads scratched.

All this for what is probably just some minor inflammation of my sesame seed shape bone in the area of concern. It is probably the results of my knees being so out of whack that the biomechanical forces on my little feet are also out of balance. Nothing an Advil and Dr Scholls can't solve.

Doctors are not only over treated by other doctors. They can be over treated by themselves.

Thursday, October 15, 2009

New York, New York redux

Back home, but not for long.

Off to Dallas in a week to lecture on sleep apnea, then flying directly to the city that never even naps to attend theNorth American Educational Forum on Lymphomain Brooklyn, see Dr Rai in Long Island, kvell over my daughter being called to the bar AND being awarded the top pro bono award in the empire state by the chief judge, catch up with old friends in the CLL world including Drs Kay and Furman, eat more great raw food, reconnect with a dear former girlfriend from high school for the first time in more than 35 years, all in the 6 days we are in the city.

Home for a week, and then...

Back to NYC to speak at a fund raiser about the need to get more bone marrow donors registered, especially in ethnic minorities. My speech must be personal and emotional and raw.

Next a gig the following weekend on adult vaccines (speaking from the CDC gospel). That is happening, thank goodness, just down the road in Anaheim, near the happiest place on earth followed by a fun McGill Alumni event in Redondo Beach to watch the Habs do battle from a cafe where they serve poutine and smoke meat (I remain a sorely tempted vegan).

Friday, October 9, 2009

Off to my Home and Native Land

Catching an early morning plane to Seattle, then it's a drive up highway 5 to visit a most wise and enlightened and silly friend in northern Washington before crossing the border to spend time with my dad in Vancouver, actually White Rock.

I will also be visiting a solid and unafraid friend from high school and his family.

Both friends are one of a kind. I am lucky to know them both.

While on the northwest coast, I feel it's my duty as a Canadian to make certain that the family gets to explore the Museum of Anthropology and Stanley Park.

But mostly it is to spend time with my old man. His two grandsons are coming along. It is not easy for either my dad or me to travel much these days. My busy schedule belies the planning and effort that goes into making my trips safe, even possible for someone whose platelets are under attack. It is not easy to pull the three generations together for family trips. So it will be good to just spend time with him.

Got a surprise on my GI biopsy report: Intestinal metaplasia. It means a recheck upper scope in 2-3 years instead of 10, as it carries a slightly higher risk of malignant transformation. More watching and waiting. Actually it rarely progresses and is a pretty trivial issue in the big picture. I got bigger zucchinis to chop.

No worries mate.

Maybe I will go off my diet in Canada and have some Granville Island Smoked Salmon. Or a Tim Horton donut.

Tuesday, October 6, 2009

Scatological studies

On my bone marrow biopsy, they found no iron stores. That is very rare in men. Could mean internal blood loss.

But wait you say, you're vegan. Couldn't that explain it? Well, vegan may have no good source of B12, but all iron comes from the ground and is found in many leafy greens (the cows you meat eaters boast of for their high iron content got theirs from eating greens). Veganism does not explain away my low iron.

But you said you are not anemic. That's reassuring, isn't it? Sorry, but that is the last place an iron deficiency shows up. An analogy: The car may still have a full tank of gas, but the petrol station is bone dry.

You might even know that ferritin, the terribly important iron binding protein, is a very sensitive marker of low iron stores and yours is normal so no worries, mate. But remember that CLL is a looking glass world where appearance can deceive, and all things protein and protean are not reliable. Ferritin levels fluctuate with inflammation and are less trustworthy in CLL.

The real contradiction is that the iron studies in my blood, the total iron, the percent that is bound, and the total iron binding capacity are all within normal limits. That makes no sense with no iron in the marrow.

Add it up and what do you get? A contradiction. Now that is familiar CLL territory.

Likely my iron is fine in both my blood and in my marrow, but the test was messed up. It was a poor specimen, and the leaching technique to get rid of the calcium for the iron stain, if not done perfectly, can botch the results.

So how is this scatological? Seems more hematological?

Because the contradiction must be resolved, I need a colonoscopy and EGD tomorrow to make sure I am not bleeding from some occult GI source. Time for a look-see. My last scope was when I turned 50, so it's time anyway.

For those of you who have experienced the prep, you know I am not leaving home tonight. I am not even venturing far from the toilet.

Monday, October 5, 2009

All remains good in the land of platelets

My platelets were in the normal range -157,000- before the first drop of today's IVIG coursed through my veins. That is a drop from 220,000 on Set 18, but that was a full 17 days ago when I last got a dose of immunoglobulin. Today the count is not only still in the normal column on the report, it is way out of the danger zone of <30,000.

In fact, they haven't been out of the normal range since Aug 21, and their nadir was a very very safe 99,000.

The fall had actually started to level out before I started treatment. ITP has been known to hit hard and then peter out.

The CT scan in August had showed possible very small splenules. Sometimes after a splenectomy, small accessory spleens, dormant since birth, get a wake-up call and start growing to do the work of the missing spleen in gobbling up dead and dying red cells and platelets. Sometimes the splenectomy itself spills a few cells in the surgery itself that find a home in some warm vascular bed and start growing up. This is called splenosis. In either case, ITP or AIHA can return.

Neither these processes, by the way, have anything to do with the return of CLL. They can happen in garden variety ITP, with no cancer as the driver.

There are special scans (heat damaged RBC or the old school liver-spleen scan) to look for the suspect tissue, though there is some controversy on which is the best method. Either needs to matched up to the CT.

A glance under the microscope is much easier, cheaper, and radiation free. It may reveal Howell-Jolly bodies, that shouldn't be there if the spleen or splenules are doing the job. I have Howell-jolly bodies.

None of this is 100% predictive.

One option is to do the special scan, see if the suspect areas on the CT light up, and if they do, consider a second and much more minor outpatient laparoscopic accessory splenectomy.

The success rate is quite variable, between a 0-66% success rate. I suspect it depends on the experience of the surgeon along with other factors, such as age. I can find no literature saying that response to first splenectomy is predictive. Or if the presence of Howell-Jolly bodies have any prognostic significance. Size of the splenules is not a factor. Seems 0.5 cm mini-organs can do yeoman's work and when they are removed the chance of a cure is the same as those with bigger born again organs. Response to IVIG does predict good results with primary splenectomy. By the time I had my primary splenectomy 2 and 1/2 years ago, I was no longer responding to IVIG. The operation didn't work. But I sure am responding well now to the infusions every 2 weeks.

That said, while IVIG is a not remitting therapy, it is getting the job done with little muss and fuss and I kind of like the idea of maybe having a mini-spleen protecting me against encapsulated cocci with flu and pneumonia season on the way.

So unless Kanti Rai tells me otherwise, no more video games to be played in my belly for a while. If I have splenules, they can relax for a spell.

I am not sure if my platelet count would be safe even without the IVIG (remember the fall had maybe stopped in the week in August prior to starting treatment), but I am not going to stop it and try to find out. IVIG is after all IMMUNE globulin. It does double duty, protecting me against all things infectious, so I am not taking any chances and am instead counting my dual blessings.

Saturday, October 3, 2009

A good night's sleep

I slept in until 11 AM and feel whole lot better. No longer unravelled. After a hardy breakfast of raw mixed nuts and juiced veggies, plus a pot of Japanese green tea, all organic of course, I will dive back into the diabetes paper. Maybe I will work in the Sukkot or tent. Combine research, fresh air and a mitzvah (commandment) by just changing where I place my tush.

If you have a few minutes, check out the link to the youtube on the real Shakespeare. Makes sense to me, but I'm no expert.

Friday, October 2, 2009

Too scattered

Too scattered to reach deep into the files of my brain to set down some organized index of what needs to be done and when to do it, too lazy to retrieve and review and digest the source material to chart my route to the land of cure, too tired to continue to dissect and critique a 27 page review article with over 50 references on diabetes management due in 3 days, too sleepy to write much more tonight.

Though Seneca has lately been tutoring my Stoic, almost Zen, approach to fate, my willful soul remains convinced that I can outrun fortune and beat the odds. There are always exceptions to the morbid statistics, but to be exceptional, I need to rest first.

There is a battle ahead, not imminent, but not beyond the horizon either, that will need more than intellect to insure victory. It will need wisdom. It will needs heart. It will need physical and mental and spiritual endurance. And, yes, Seneca, it will need fortune to smile on me.

And it needs some planning soon. To paraphrase my boyhood hero Arnold Palmer (I was tickled to meet him at the Canadian Open when I was about 11 years old), the more I prepare, the luckier I get.

Thursday, October 1, 2009

Charity

Just a quick note to say that those of you who did the direct to consumer marketing interview on Rituxan in Irvine and mentioned my name can feel good about giving money to charity. I recently received a check for $250 for the "referrals" and forwarded it for research and CLL support (CIG).

About Me

BkoffmanMD@gmail.com
A family doc and husband of 1 and father of 4 and grandfather of 3 who loves his family and his work. I live with no TV and no microwave, but wouldn't last a minute without friends, art, music, books and the beach. Hockey, good jokes and exotic travel are pretty important too. Writing, Talmud and Zen give meaning to my life. My diet is organic vegan, often raw. I hope the blog makes the load lighter and the path both safer and more fun for those who read it or are going to similar places. I want to help. I crave your comments. If you are new to the blog, check out the portrait my son Will painted (it is the first post), and my very first text post.